May 262011
 

Welcome back! This part of the IOM report covers adults aged 20 to 60. There are more data available for adults than adolescents, so this part’s broken up a bit different from the last. As a reminder: GLBT (or LGBT – same meaning, different order) stands for gay, lesbian, bisexual, and transgender. I frequently do use GLB separate from T. That is intentional, not a typo. Also, the full report is available here – you can read it online for free.

The best studied aspects of health:

  • Mood/anxiety disorders: There are conflicting data here, but the consensus so far is that GLB people have higher rates of these problems. There’s almost no research on transgender people, but one preliminary study found that around half of transgender people have depression. Yikes!
  • Suicide/Suicidal ideation: LGBT people as a whole appear to be at higher risk. Bisexuals and transgender people appear to be at an even higher risk. Risk also seems to vary by age, sex, race/ethnicity, and how far out of the closet a person is.
  • Cancer: Gay and bisexual men are definitely at a higher risk for anal cancer than heterosexual men. This risk is linked to having anal HPV, which can be spread by anal sex.

Somewhat studied:

  • Eating disorders: May be more common for GLB people than heterosexuals, but we’re not sure. No data on transgender people.
  • Sexual: Gay/bisexual men don’t appear to be at an elevated risk for erectile dysfunction. Transgender people who have had sexual reassignment surgery may be at a higher risk for sexual difficulties…not entirely surprising given the potential for nerve damage from any surgery.
  • Cancer and obesity: Lesbian/bisexual women may be at a higher risk for breast cancer than heterosexual women.
  • Hormone replacement therapy -may- affect cardiovascular health, but it’s unknown.

Essentially not studied: Reproductive health (including the effects of hormone therapy on fertility for transpeople), cancer (especially in transgender patients), and cardiovascular health

Risk factors:

  • Stigma/Discrimination/Victimization: As we all know, LGBT people face these problems all the time.¬† Stigma is strongly associated with psychological distress. Bisexuals have reported facing discrimination from both the straight and gay communities. One study of transgender people found that 56% had faced verbal harassment, 37% had faced employment discrimination, 19% had faced physical violence.
  • Violence: LGBT people are at an elevated risk for suffering violence. LGBT people do experience intimate partner violence, but the statistics and relative risk are unknown.
  • Substance Use: LGBT people may be more likely to use substances, especially tobacco (read my previous post on this).
  • Childhood abuse: LGB may have higher rates of childhood abuse.

Potential protective factors (LGB): supportive environments, marriage, positive LGB identity, good surgical/hormonal outcomes (T)

As for access/quality of health care? Er…it’s complicated. GLB people get less regular screening (like pap smears and basic physical exams) than heterosexuals and use the emergency room more often. Two biggest obstacles to getting good health care?: problems with the health care providers. This could be perceived discrimination (thinking that someone is acting in a discriminatory way, whether that person is or not), or simply lack of knowledge on the part of the provider. One study found only 20% of physicians had received education about LGBT health issues. That’s only¬† one in five! I will note that this is improving – medical schools, depending on the school and its location, are starting to teach LGBT cultural competency more than they used to.

Lack of insurance is another barrier, and it especially affects transgender people. The services they need, like hormone therapy and sexual reassignment surgery aren’t covered by insurance. In addition, one study found that a third of transgender people had been treated ill by a physician.

Next time: Older Adults and conclusions…

Mar 072011
 

A report recently came out looking at trends in the medical literature regarding LGBT people. This is a meta-analysis (i.e., it is an article summarizing the original research of others – it is a secondary source) that looked at articles from 1950-2007.

Findings include:

  • Estimations of percentage of the population that is LGBT ranges from 2 to 10%, depending on the survey. In the United States, this should be between 6 and 30.4 million people.
  • Lesbians have a higher risk for breast and gynecological cancers. Gay men are at higher risk for anal cancer. We don’t know if these are because of genetics (homosexuality may have a genetic root), sexual practices, or culture.
  • The biggest barrier to health care for LGBT patients is stigmatization by health care providers, because of poor education and training: “Providers as a whole need to better understand the distinct difference between LGBT status and persons with ‘high risk’ sexual behaviors.” (pg 166)
  • There is an overemphasis in the literature on sexual behavior-related topics. About 1/3rd of all papers published about LGBT people are about HIV, AIDS, STIs, and other related illnesses. This is by far the biggest group of papers. About 13% of papers are about mental health issues, and another 12% are stigmatizing articles about the causes and treatment of homosexuality. All other topics are covered by less than 9% of papers. For example, only 3.28% of papers deal with patient-health care provider interactions, and 2.66% deal with transsexual issues. This overemphasis means that we don’t have enough information about other illnesses that affect LGBT people.
  • Some research specifically excludes LGBT people with no clear explanation or reasoning behind it. This is actually against NIH research policy – populations canNOT be excluded without reason.

Citation:

Snyder, J. E. (2011). Trend Analysis of Medical Publications About LGBT Persons: 1950-2007. Journal of Homosexuality, 58: 164-188.

Jan 102011
 

The HPV (human papillomavirus) vaccine Gardasil has just been approved for use in preventing anal cancer (Source). HPV is a sexually transmitted disease that causes genital warts and has been implicated in some cancers, including anal and cervical cancer. The majority of anal and cervical cancers are associated with HPV (Source).

HPV is common (around 50% of the US population has it) and difficult to control. HPV has a number of different strains. Some cause warts (including hand and genital warts), and some cause cancers (Source). It spreads by skin-to-skin contact, so any activity involving touching or licking genitals or anus can spread it. Barriers are useful in prevention, though not completely effective. As with all STIs, having few sexual partners is considered a preventative measure. Populations considered to be at high risk for HPV include men who have sex with men (presumably because of unprotected anal sex), people having anal sex, men who are not circumcised, and people with multiple partners (Source).

Gardasil is a three-shot series. It can’t grant immunity once a person’s been exposed to HPV, so it’s recommended for people who are not yet sexually active.

Anal cancer happens in both men and women, and is largely caused by HPV. Risk factors separate from the HPV-related ones include: smoking, having HIV, having a compromised immune system, and having anal sex (Source).

The FDA’s approval comes on the heels of a study showing that, in a high-risk population (men who have sex with men), Gardasil was shown to be 78% effective in preventing infection with the HPV strands that cause anal cancer (Source).

I think this is fabulous. More tools have definitely been needed in preventing HPV-related cancer. Anal cancer also seems to be something that’s rarely talked about, so I hope this will spur discussion. I certainly have further questions:

Resources and Sources:

Anal Cancer Overview

HPV Fact Sheet

FDA News Release

Wikipedia: HPV

Wikipedia: Anal cancer